Medical device with safety features

ABSTRACT

There is provided a portable medical device for injecting insulin comprising a blood glucose meter, a first display that is capable of displaying the blood glucose content of a blood sample as determined by the blood glucose meter, means for injecting insulin in a patient comprising means for setting the amount of insulin to be injected comprising a second display that shows the amount of insulin to be injected characterized in that the device comprises a deactivation means that automatically switches off the first display.

The present invention relates to an improved device for injecting amedicament to be used by diabetes patients, or other patients thatself-medicate injectable drugs.

BACKGROUND OF THE INVENTION

Diabetes patients that inject insulin have to check their blood glucosevalue and carry out insulin injections, sometimes several times everyday. They also need to log their blood glucose values and register theamount of insulin that has been injected in order to monitor thedisease. Today this requires several different devices: means fortesting blood glucose including means for taking a blood sample (such asa lancet), disposable test strips and a blood glucose meter; an insulininjection device, extra insulin cartridges, replacement needles and alsoa log book and writing utensils for registering blood glucose values andinjections. The diabetic patient has to carry all these items with himor her, which is not only a hassle but also a risk for the patient,since losing equipment puts him or her at danger, since proper treatmentis then perhaps not achieved.

The amount of insulin that the patients injects is based on the bloodglucose measurements. Injection of an incorrect amount of insulin isdangerous to the patient. Therefore it is important that this procedureis carried out in a correct and safe manner.

Furthermore, since it is very important that the patient actually treatshim or herself it is desirable that self-medication causes minimalinconvenience for the patient and affect the patient's life style aslittle as possible.

In order to solve this problem there has been developed devices thatintegrates all these functionalities, for example WO2009027950 whichdescribes a portable medical device that integrates blood glucosemeasurement and insulin injection. It has a lancet for obtaining a bloodsample. The lancet, and the injections means are placed on the same endof an elongated housing in order to avoid blood splashing getting intouch with mechanical movable parts and/or electronic parts inside thehousing.

The site http://www.brightercompany.com/product-information as visitedon Nov. 6, 2013 has a film that discloses a medical device. It has atest strip port located adjacent and such that the test strip isparallel to the injection needle. It has one display that shows bothblood glucose concentration and the amount of insulin to be injected bythe device.

The diabetes patient is used to carry out the different steps of bloodglucose measurement and insulin injection in a certain order and in acertain manner. This contributes to that the patient carries out theprocedure in a safe manner. This is particularly important since thecognitive abilities of diabetes patients may sometimes be compromiseddue to fluctuating blood glucose levels.

There is also a need for improved logging of injections. Currentlyregistration of blood glucose measurement are usually carried outmanually by the patient. Manual registrations are prone to human errors,for example the patient may forget to register a value or enters thewrong value. Automatic logs have been proposed, for example inWO2012068214.

Before each injection it is important that the user primes the injectionneedle, in order to ensure that there are no air bubbles and no clogs inthe needle. This is carried out by ejecting a small amount of medicationfrom the needle. A disadvantage with current automatic logs is that theycannot distinguish between injection events and priming events. WO2009083600 proposes a medical device that can log insulin injections anddistinguish between injections events and priming events depending onthe speed of the ejected liquid during ejection. However, that inventionassumes that the ejection speed is controlled by the device. In deviceswhere the injection speed varies, for example because the user pushes aplunger with different speed from time to time, such a solution cannotbe used.

Thus, there is a need for improved log that can distinguish betweeninjection events and priming events in safe and convenient manner.

SUMMARY OF THE INVENTION

In a first aspect of the invention there is provided a portable medicaldevice for injecting insulin comprising a) blood glucose meter, b) afirst display that is capable of displaying the glucose concentration ofa blood sample as determined by the blood glucose meter, and c) meansfor injecting insulin in a patient comprising means for setting theamount of insulin to be ejected by the device, comprising a seconddisplay that shows the amount of insulin to be ejected, where the devicecomprises a deactivation means that switches off the first display whenthe means for setting the amount of insulin to be ejected is set to asetting that permits the ejection of insulin.

The device has the advantage that the user does not confuse the bloodglucose measurement shown on the first display with the setting of theinsulin injection means. The user does not think that the value of theblood glucose measurement is the amount of insulin that he or she hasjust injected. Thus, the user is guided through the procedure in a stepby step fashion.

The first display can be an electronic display such as an LCD or an OLEDdisplay. This has the advantage that the display is small and can show amultitude of symbols and figures, and moving objects.

The second display can be a mechanical display. Mechanical displays arevery reliable and does not require the use of electricity. This has theadvantage that the entire injection means can be user-powered, whichresults in reliable and battery-free operation. The fact that there areno electrical components results in the injection means also decreasesthe risk for electric shock for the user.

The deactivation means may comprise a sensor that senses when the meansfor setting the amount of insulin to be ejected is set to a setting thatpermits the ejection of insulin. The sensor may be a position sensor.

The sensor is suitably connected to a processing unit that controls thefirst display. The deactivation means may also include a processing unitand connections between sensor, processing unit and the first display.

The drive mechanism of the means for injecting insulin is preferablypowered by the user.

In one embodiment, the first display is automatically switched on whenthe means for setting the amount of insulin to be ejected is set to asetting that does not permit the ejection of insulin.

The work flow when using the device is preferably indicated on thedevice so that the user makes a mental connection between each of thevarious steps to different ways of interacting with the device. This canachieved as follows.

The housing of the device can be arranged to further separate thevarious components. For example, the angle between a line that isperpendicular to the surface of the first display and a line that isperpendicular the surface of the second display may be at least 60°.

When the device is a multifunctional device that also includes a lancetfor making a blood sample, the device can be further designed to furtherseparate the different steps of taking a blood sample, making a bloodglucose measurement and injecting insulin. Assigning the variousfunctions to ways of interacting with the device the user is guidedalong the procedure. The ways of interacting with the device is distinctfor each of the steps of taking a blood sample, making a blood glucosemeasurement, injecting insulin and logging events.

The design of the inventive device makes it easier to remember thecorrect sequence of the various procedures.

Thus the device may have a housing and the device additionally comprisesa site for connecting a lancet located in one end of the housing andwhere the means for injecting insulin includes a cartridge housing forreceiving an insulin cartridge where said insulin cartridge can beconnected to an injection needle, said injection needle being located,when connected to the cartridge, in the opposite end of the housing andwhere an injection actuator is located in the same end of the housing asthe site for connecting a lancet.

The first display may be located on the housing approximately in themiddle between the site for connecting a lancet and the site forconnecting the injection needle on the insulin cartridge. The anglebetween the lancet and the injection needle may be from about 160° to−220°.

When the device has a site for connecting a lancet and where the bloodglucose meter comprises a test strip port such that the angle betweenthe test strip, when inserted into the test strip port, and the lancetmay be from 45° to 135°. The angle between the test strip, when insertedinto the test strip port, and the injection needle, when attached, maybe from 45° to 135°,

In a second aspect of the invention it is provided a method for logginginsulin injections carried out by a medical device with injection meanscomprising the steps of a) determining the amount of insulin that wasejected by the medical device, b) storing, in the memory of the device,the time of ejection together with data from a) as an ejection event, c)determining, with a proximity sensor in the device, said proximitysensor able to sense the proximity of a solid object in the direction ofthe injection needle, if ejection by the medical device takes place inthe proximity of a solid object, and d) tagging the ejection event as aninjection event if the ejection takes place in the proximity of a solidobject and tagging the ejection event as a priming event if the ejectiondoes not take place in the proximity of a solid object.

The method can be used for logging events in electronic log that can beconveniently accessed by the user through a user interface on thedevice. The electronic log is an improvement of current logs that cannotdistinguish between real injections and priming ejections. Thus the useris provided with a reliable log for injections and glucose measurementswhich improves safety.

Preferably an ejection event is tagged as an injection event if, wheninsulin is ejected by the device, there is a solid object within athreshold distance of the medical device. The threshold distance may be200 mm.

In an alternative embodiment where an ejection event is tagged as aninjection event if, when insulin is ejected, the distance from thesensor to the tip of the needle (D₁) is larger than the distance fromthe sensor to a solid object (D₂) and where D₁−D₂≥0.1 mm. In oneembodiment the method is such that information about the injectionevents are accessible to the user thought a user interface on themedical device and information about the priming events are notaccessible to the user via a user interface on the medical device. Thepriming events are only accessible, for example through a data port, orafter entering a code. Thus, the priming events are not visible to theuser. This has the advantage that the user does not confuse the primingevents with real injections in the log. However, the priming events arestill accessible for doctors and nurses and persons that carry outservice on the device.

In one embodiment the method comprises the additional step of the userusing a user interface to tag an injection event with additionalinformation regarding one selected from the group consisting of a bloodglucose measurement, health status, taking a meal and exercise.

In one embodiment the method comprises the additional step of the deviceautomatically tagging a injection event with a blood glucose measurementif the blood glucose measurement has been made within 30 min of the timepoint of the injection event. Blood glucose measurements are affected byinsulin injections, meals, exercise and illness. The advantage of thisarrangement is that, when the user reviews blood glucose measurements,he or she can take meals, etc. into account in a convenient manner. Theadvantage with automatic tagging is that tagging occurs even if the userforgets to tag.

In a third aspect of the invention there is provided a medical devicesuitable to carry out the method of the invention. Thus there isprovided portable medical device for injecting insulin comprising ameans for injecting insulin in a patient, means for automaticallyrecording the amount of insulin that is injected at a certain time pointas an injection event and a proximity sensor that can sense theproximity of a solid object in the same direction as the injectionneedle where the medical device is configured to tag the ejection eventas an injection event if the injection takes place in the proximity of asolid object and tagging the ejection event as a priming ejection if theejection does not take place in the vicinity of an object. The sensor issuitable an infrared sensor. The device can be configured to tagejections as injections when the distance from the front plate of thecartridge housing to an object is less than a threshold value T that isdescribed in more detail below. The threshold value can be 200 mm.

Definitions

As used herein, “user” and “patient” refers to the person that uses thedevice to test blood glucose and inject himself or herself with insulin.

Although it is frequently referred to insulin in this application, theinventions disclosed herein may be useful for devices for injectingother medicaments that are self-administered by the patient, such as,for example growth hormone.

“Insulin” covers not only insulin in its natural form but also insulinvariants and analogs that are administered to diabetic patients.

“Tagging” means storing additional information about a database entry ina database.

“Ejection” means expulsion of a liquid medicament from a medical devicewith injection means, for example by a plunger creating a pressure.Typically ejection is carried out from the tip of an injection needlewhich can be attached to the device.

“Injection” is ejection where the liquid medicament, after beingejected, enters into a solid object (typically the body of a patient).

“Priming” is ejection where ejection does not take place into a solidobject. For example the liquid medicament may be sprayed into the air,or drip from the tip of the needle.

When it is referred to “date and time” or similar herein, it is meant afixed time point. A fixed time point does not necessarily have to beexpressed as date and time.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a schematic overview of the interior of a medical device.

FIG. 2-3 are schematic overviews of an injection needle and an insulincartridge.

FIG. 4-5 shows examples of the exterior of the device.

FIG. 6 shows an example of arrangement of sensors.

FIG. 7-9 are examples of an arrangement of the second display, whereFIG. 7 shows the interior of a medical device and FIGS. 8-9 shows theexterior.

FIG. 10 is a schematic overview of the connection of a sensor to aprocessing unit.

FIG. 11-13 show examples of arrangement of first and second displays andother features of the device.

FIG. 14 shows the threshold distance for a proximity sensor in thedevice.

FIG. 15 is a flowchart showing a method for logging insulin ejectionevents.

FIG. 16 is a schematic overview of an example of database.

FIG. 17 shows various connections to a processing unit.

FIG. 18-19 are flowcharts that show examples of logging of blood glucosemeasurements and ejection events.

FIG. 20-22 show how a proximity sensor can be used for classifyingejection events.

FIG. 23-24 shows examples of an electronic display in a switched-offstate.

FIG. 25-27 shows details of an example of a drive mechanism of injectionmeans.

DESCRIPTION OF EXEMPLARY EMBODIMENTS

FIG. 1 is a general schematic overview of the medical device 1, which ina preferred embodiment comprises injection means comprising a cartridgehousing 10. The cartridge 40 is placed by the user in the cartridgehousing 10 of the device 1. Injection of insulin is carried out with aneedle 42 the needle hub 44 of which is attached to the top 43 ofcartridge 40 by the user as shown in FIGS. 2 and 3. The cartridge 40 andthe needle 42 are usually supplied separately from the device 1 and doesnot form a part of this invention. Returning to FIG. 1, the injectionmeans further comprises a drive mechanism 13 that causes the ejection ofinsulin through the needle 42 and means for setting the amount ofinsulin to be injected 5 (dose setting means).

The drive mechanism 13 can comprise a plunger 41 that causes theejection of medicament through the needle 42 when it travels in thelongitudinal direction of the cartridge housing. The plunger 41 may beadapted push on a second plunger 45 supplied in the cartridge 40. Thefront of the main part of the cartridge 40 can rest against the frontplate 4 of the cartridge housing 10 as shown in FIG. 14 (note that theneedle points in the opposite directions in FIG. 1 and FIG. 14).

Suitably the device 1 also comprises a blood glucose meter 9.

Preferably the device 1 is portable. Then the user can easily bring thedevice with him or her.

A preferred design of the device 1 comprises a housing 7 which is ahollow body that contains the various parts of the device 1. Preferablythe housing 7 is of a size and shape that enables the user to rest thedevice in the hand. The housing may have one or more detachable partsthat serves as cover 8, for example as cover for the injection needle.The housing can be made of plastic or metal, where plastic is apreferred material. The drive mechanism 13 is preferably enclosed in thehousing 7, as is processing unit 19 and glucose meter 9.

Typically the device 1 is used in the following manner. First the useruses the lancet 22 to puncture the skin in order to obtain a drop ofblood. The drop is then brought in contact with the end of a test strip.The other end of the test strip is entered into blood glucose meter 9through the test strip port 2. The blood glucose meter 9 then carriesout measurement of the glucose content of the blood and presents a bloodglucose concretion value to the user on a display 3. Based on thisvalue, the user decides how much insulin that is to be injected. Theuser then sets the amount of insulin with the dose setting means 5 andinjects himself/herself.

The device 1 has a user interface with at least one display. The displaycan show various kinds of information, such as blood glucosemeasurements, injection events, date and time. The device 1 hasinjection means, including a display that shows the amount of insulin tobe injected and a drive mechanism 13 that preferably is powered by theuser (user-powered). Such injection means has proven to be veryreliable, as they require no electricity and the drive mechanisms can bemade very durable. Examples of user-powered drive mechanism forinjecting insulin includes mechanisms that are powered by the userpressing an injection actuator. The pressing power is mechanicallytransferred to the plunger 41. Examples of user-powered drive mechanismare known in the art, examples include U.S. Pat. Nos. 5,593,390,6,221,046, 5,279,586 and WO2009027950. A user-powered drive mechanismmay suitably have a mechanical display. These require no electricity andare very reliable.

However, it is also desirable that the device 1 has a display that issmall, light and that can show a variety of symbols and letters and thatcan be easily connected to a microprocessor. Therefore, in a preferredembodiment, the device 1 has two displays; a first display 3 which isnon-mechanical, preferably an electronic display such as an OLED, a PDPor an LCD display, and a second display 6 which is mechanical and whichshows the dose setting.

FIG. 4 shows an example of the exterior of the device 1. In the housing7 is mounted first display 3. The second display 6 and dose settingmeans 5 are also visible. A part of the housing 7 forms a removable cap8 that protects the injection needle. Thus when the cap 8 is on, theneedle 42 is inside the housing 7.

FIG. 5 shows essentially the same as FIG. 5, as it shows the housing 7of the device 1 with the cap 8 removed to expose the cartridge housing10, needle 42 (with an additional protective cap). First display 3,second display 6 and dose setting means 5 are also visible.

The medical device 1 will now be described in more detail with referenceto FIG. 1. Preferably the device 1 is equipped with a blood glucosemeter 9 as shown in FIG. 1. Blood glucose meters are well known in theart. Usually blood glucose measurement is carried out with disposabletest strips 28 as is well known in the art. The test strip 28 may be ofthe kind that contains one or more chemicals that react with glucose inthe blood in such a way that the blood glucose concentration can bemeasured. For example the test strip is a standard glucoseoxidase/ferrocyanide test strip where the glucose concentration affectsan electric current in a way that can be converted to a blood glucoseconcentration measurement.

Suitably, blood glucose measurement by glucose meter 9 is automaticallystarted when a test strip 28 is inserted into the test strip port 2. Forexample, a sensor senses when a test strip is introduced into the teststrip port 2. An example of how test strip 28 is inserted into teststrip port is shown in FIG. 13. The user then produces a drop of blood,preferably by using the lancet 22 as described below. The user thentouches a drop of blood to the edge of the test strip which absorbs theblood and delivers it by capillary action along the test strip 28 to thesite where the chemical reaction occurs. Typically a blood drop with avolume of 1-20 microliters is used.

By means of the integrated blood glucose meter 9 the glucoseconcentration is determined and indicated on the first display 3 withina few seconds, to allow the user to go to the injection mode and adjustthe amount of insulin to be injected. Blood glucose measurements areusually expressed as mmol/L or mg/L and the device can suitably show theblood glucose concentration in one of these units. Preferably the userprimes the injection means before setting the amount of insulin to beinjected.

The means for injecting insulin comprises a cartridge housing 10 forinserting a cartridge 40 pre-loaded with insulin. The cartridge housing10 is adapted to receive an insulin cartridge 40. The cartridge housing10 has at least a front plate 4 that limits the movement of the insulincartridge 40 in the direction of injection. The needle 42 in FIG. 2 andFIG. 3 can be snapped on or screwed onto the top of the cartridge 40 orconnected to cartridge 40 with a luer lock or connected by othersuitable means. The cartridge 40 can be replaced in a simple manner bythe user.

The injection means comprises a drive mechanism 13 which causes theplunger 41 to move when the user interacts with the device to causeejection of insulin, for example by pressing actuator 12. The drivemechanism 13 can be carried out in different manners as long as it issuitable to inject insulin from an insulin cartridge 10 in a patient andcan be combined with sensors as described below.

The means for injecting insulin comprises means 5 for setting the amountof insulin to be ejected by the device (dose setting means). The dosesetting means 5 can be a rotatable dosing knob 5, but it can be any typeof means by which the user can instruct the drive mechanism 13 of theinjection means of device 1 to change its dose setting. For example itmay be a plus/minus buttons or a lever. The rotatable dosing knobsuitably has grooves for enhancing the grip. The amount of insulin to beejected by the device 1 is shown on a display 6, referred to as thesecond display 6, which is described in more detail below. The dosesetting means 5 is connected to, and may form a part of the drivemechanism 13. The drive mechanism 13 can cause the plunger 41 to bedisplaced thus creating a pressure in insulin cartridge 40 in thecartridge housing 10 by pressing on second plunger 45 in the cartridge40. The pressure causes ejection of insulin trough the needle 42connected to the cartridge 40. The drive mechanism 13 can cause theplunger 41 to be displaced to in a variable manner. The setting of thedose setting means 5 determines how far the drive mechanism 13 displacesplunger 41 during ejection.

The dose setting means 5 should have at least one setting that does notallow the ejection of insulin. When the dose setting means 5 is in thisposition no insulin is ejected when the user instructs the device toeject insulin, for example when the user applies pressure to theactuator 12. Thus, the plunger 41 does not move when the user pressesthe actuator 12 when the dose setting means 5 is in this position.

The dose setting means 5 should have at least one setting that allowsthe ejection of insulin from the cartridge, for example a fixed amountof insulin. Typically the settings for the second display 6 are 0, 1.0,1.5, 2.0, 2.5 and so on representing insulin units, where one unit mayrepresent 0.01 ml of medicament. The “0” setting is a setting that doesnot allow ejection of insulin. The settings 1.0, 1.5, 2.0, and 2.5 aresettings that allow the ejection of insulin.

The means for injecting insulin also comprises an injection actuator 12.This may be in the form of knob that is pressed by the user. The dosingknob and the injection actuator may be integrated in the same unit suchthat the rotatable dosing knob 5, 12 can be depressed, and when it isdepressed ejection takes place.

The drive mechanism 13 for ejecting insulin can be an electric pump.Preferably, however, it is a user-powered drive mechanism. Examples ofuser powered mechanical drive mechanism and dose setting means andmechanical displays are disclosed in U.S. Pat. Nos. 5,593,390,6,221,046, 5,279,586 and WO2009027950.

The drive mechanism 13 can be powered by the user such that when theuser uses the actuation means 12 the power is transferred to the drivemechanism 13. The amount of insulin to be ejected is set by turning thedose setting means 5 so that mechanism 13 can move plunger 41 to ejectinsulin from cartridge 40 and the dose setting means 5 determines howfar the plunger 41 travels.

An example of a user powered drive mechanism and a mechanical display isshown in FIG. 25. The mechanism is shown when set in a position thatdoes not allow injection of insulin. Sleeve 14 serves to display thedose setting digits to the user and to interact with switch 18 asdescribed below. Sleeve 14 has dose settings marked on the outside.These marking is visible to the user, for example through a window asseen in FIG. 7. Sleeve 14 can rotate with turning of dose setting means5. When a user rotates dose setting means 5 to set the dose, sleeve 14rotates with it. Sleeve 14 then moves to the right in the figure due tothreading 57. Nut 52 rotates together with sleeve 14 by means of coneclutch 53. This makes the nut 52 go to the right in the figure. Themovement of nut 52 from its left-most position sets the injection meansto a setting that allows the injection of insulin.

When the user has set the dose he or she is not ready to eject insulin.The injection actuator 12 is connected at the end of the sleeve 14. Theinjection actuator 12 can be pressed by the user. The arrow in FIG. 25indicates direction of pressing. Upon pressing the injection actuator 12then moves to the left in the figure. The outer surface of injectionactuator 12 is covered with a material (for example rubber) that causeshigh friction between the finger of the user and the injection actuator12. When the user presses the injection actuator 12, the nut 52 isreleased from sleeve 14 by cone clutch 53 and moves to the left to thesame extent that the injection actuator 12 is pressed. Injectionactuator 12 then, subsequently, presses on sleeve 14 which turns withaid of threading 57 and moves to the left. Release of cone clutch 53 isachieved by gap 58. Gap 58 causes injection actuator 12 to first presson nut 52 and then, after being presses slightly more, on sleeve 14,causing cone clutch 53 to be released. Nut 52 is not allowed to turnwhen pressed by injection actuator 12 because of the high frictionbetween the finger of the user and the outer surface of injectionactuator 12 and because the cone clutch 53 is released. Nut 52, however,moves to the left when injection actuator 12 is pressed. This movementcontinues until the right end (in the figure) of the turning part 27 hasreached the inner surface 56 of the injection actuator 12. This movementof nut 52 causes turning part 27 to turn inside it with the aid ofthreading grooves 54 and to feed threaded plunger 41 to the left withthe aid of threading 55. Thus plunger 41 does not turn. A comparativelylarge movement of injection actuator 12 is thereby geared to a muchsmaller movement of plunger 41 due to different steepness of threading54 and threading 55.

Turning part 27 feeds plunger 41 towards the left and causes ejection ofinsulin each time user presses the injection actuator 12 (presuming thatthe dose injection means 5 is set to a setting that allows the ejectionof insulin). Plunger 41 is returned to the starting position when thecartridge 40 is replaced. FIG. 26 and shows the cone clutch 53 in itsengaged state and FIG. 27 shows the clone clutch in its disengagedstate.

The drive mechanism 13 can be combined with a deactivation means thatsuitably comprises at least one sensor for sensing movement or settingsof the drive mechanism 13, or dose setting means 5. In general, sensorsthat are capable of detecting movement in a mechanism or the setting ofa mechanism are well known. The sensor may be a position sensor, such assetting mean sensor 17 that senses the position of a part of drivemechanism 13. In particular the setting mean sensor 17 may sense theposition of a part of a drive mechanism 13 that changes position as thesetting of the dose setting means 5 changes. The part of drive mechanismbeing sensed by setting mean sensor 17 is preferably a part, theposition of which, is determined by the setting of dose setting means 5.An example of such a part of drive mechanism 13 is member 29 of sleeve14. The at least one sensor is connected to and arranged to communicatewith processing unit 19.

Preferably the device has a deactivation means comprising a sensor 17that can sense when the dose setting means 5 is set to a setting thatpermits the drive mechanism to eject insulin as is described below. Thedeactivation means which is an important part of the invention isdescribed further below, as it can be used to switch off first display3.

The device 1 has a user interface that includes one or more displays,buttons for navigation in menus, and an input device for entering input.The user can obtain information such as status of the device, bloodglucose measurements and the setting of the dose setting means 5 from atleast one display.

In a preferred embodiment, however, the device 1 has at least twodisplays: a first display 3 and a second display 6. In this embodimentthe purpose of the second display 6 is mainly to show the setting of thedose setting means 5, thus to show the amount of insulin to be ejected.In a preferred embodiment the second display 6 only displays the settingof the dose setting means 5. Other information such as blood glucosemeasurements, are shown on the first display 3. In particular, the bloodglucose measurements are shown on the first display 3. In one embodimentthe device has one mechanical display (second display 6) that is capableof showing the amount of insulin to be ejected by the device and atleast one electronic display (first display 3) capable of showing bloodglucose measurements. A mechanical display preferably works withoutbeing powered, for example by electricity. Thus it can display the dosesetting (the amount of insulin to be ejected) without being powered.

The first display 3 can be either switched on or switched off. Forpurposes of this application, “switched on” means that the first display3 is capable of showing letters and numbers, for example a blood glucosemeasurement, and “switched off” means that the first display 3 does notshown any letter, digit or symbol that can be confused with a letter ora digit of a blood glucose measurement. For example, the first display 3can show lines or circles or other figures that have a low probabilityfor being mistaken for an actual blood glucose measurement; and still beconsidered to be switched off. This indicates to the user that the firstdisplay 3 is not broken but merely that it is currently not displayingany information. For example, if most of the display shows several rowsof dashes (as in FIG. 24) it will considered to be switched off. Also,for example, if the first display 3 shows several rows of the samedigit, for example the digit “8” (as in FIG. 23) it will also beconsidered be switched off, since this will probably not be mistaken foran actual glucose reading or an injection event. The deactivation meansoff course also switch off the first display 3 by causing the processingunit 19 to cut the power to the first display 3. I will then not be ableto show any letter, digit or symbol.

FIGS. 7-9 shows one way of arranging the second display 6 when it is amechanical display. Here the second display 6 is arranged on a shortside of the device 1. Sleeve 14, which is a part of drive mechanism 13,rotates with the dose setting means 5, the sleeve 14 having dosemarkings on the outside. The dose marking may be written in aspiral-like fashion on outside of sleeve 14 since the sleeve 14 may movewhen the dose is set. Sleeve 14 is arranged in the housing 7 such that asection of the sleeve 14 is visible through a window 15 in the housing7, as shown in FIGS. 7-9. FIG. 8 shows the second display 6 seen fromabove and FIG. 9 is an enlargement of FIG. 8. The sleeve 14 is connectedto the dosing knob 5 such that the sleeve 14 rotates when the dosingknob 5 is turned. The selected dose is shown in the window 15 indicatedby an arrow or line 16 on the housing 7. The setting of sleeve 14determines the amount of insulin to be ejected by drive mechanism 13 (asit determines how far 52 moves to the right in FIG. 25 nut). The seconddisplay 6 may also be such that all the figures are visible and that theselected number is indicated by a line or an arrow.

In a preferred embodiment the first display 3 is automatically switchedoff by a deactivation means, that may include, for example a positionsensor, when the dose setting means 5 is set to a setting that permitsthe ejection of insulin. Thus, the first display 3 is switched off whenthe dose setting means 5 it set to—for example—1.0, 1.5, 2.0, 2.5 and soon, but active or switched on when the dose setting means 5 is set tothe at least one setting that does not allow ejection of insulin, suchas 0 (zero) or any other setting that results in that no insulin can beejected. For example, besides the setting 0 (zero) there may also be an“off”-setting that also inactivates the insulin injection means, andthat allows the activation of the first display 3.

This arrangement directs the attention of the user to the second display6 which shows the amount of insulin to be ejected. This reduces the riskthat the user sets the wrong value of the dose setting means 5. Forexample, there is no risk that the user looks at the blood glucosemeasurement and believes that the value of the blood glucose measurementis the dose to be ejected. Furthermore it directs the user to take thenext step in the procedure and complete that step and not backtrack tothe previous step (which is the blood glucose measurement step). Thus,the user is guided towards taking the next step in the procedure.

A schematic diagram of an example of the deactivation means of thedevice is shown in FIG. 10. When the dosing knob 5 is turned, a settingmean sensor 17 which may comprise a switch 18 sends a signal to aprocessing unit 19 which switches off the first display 3. The settingmean sensor 17 may for example comprise a spring that causes a member topush on a turning part of the dose setting mechanism of the drivemechanism 13, said member moving a switch 18 when the member enters agroove in the turning part of the dose setting mechanism. The groove ispositioned such that the member can enter the groove only when the dosesetting knob 5 is set to the at least one setting that does not permitejection of insulin, for example a zero setting.

Another example of such a setting mean sensor 17 is shown in FIG. 6which shows a detail of the mechanism of FIG. 25. Switch 18 is arrangedto detect downward and turning motion of sleeve 14 which sets the amountof insulin to be ejected. When sleeve 14 is in its most downwardposition the drive mechanism 13 is set to zero and member 29 of sleeve14 is in contact with switch 18. The causes the first display 3 to beswitched on. When the user turns the setting knob 5 to set an amount ofinsulin to be ejected sleeve 14 turns and moves upward in FIG. 6 so thatmember 29 releases switch 18 which sends a signal to processing unit 19.This signal causes the first display 3 to be switched off.

The deactivation means can be arranged in many other ways. For example asemiconductor accelerometer of the type used in cell phones (smartphones) can be used for sensing the movement or position of a part ofdrive mechanism 13.

The dose setting means of the user-powered drive mechanism of U.S. Pat.Nos. 5,593,390, 6,221,046 and WO2009027950 can be easily adapted by aperson skilled in the art to be sensed by setting mean sensor 17 andejection sensor 33. Those are examples of injection means that can beused in embodiments of the invention. For example, U.S. Pat. No.5,593,390 discloses an injection means with cam lobes that affect acounter that can serve as the sensor 33.

The device can be such that the first display 3 is automaticallyreactivated when the dose setting means 5 is set to zero. This is aconvenient manner for the user to reactivate the display if necessary,for example if the user has forgot the blood glucose value and mustre-check this. At the same time it forces the user to set the value ofthe dose setting means to zero if he or she needs to switch on the firstdisplay. This can be achieved by setting mean sensor 17 sensing that thedose setting means 5 is set in a position that does not permit theejection of insulin. As discussed above, when the user sets the dosesetting means 5 to zero, sleeve 14 is its most downward position in FIG.6. When sleeve 14 is in this position, member 29 is in contact withswitch 18 and this sends a signal to processing unit 19 which causesfirst display 3 to be switched on.

In one embodiment the first display 3 is automatically switched on whenejection of insulin has been completed. With reference to FIG. 25 andFIG. 6, the dose setting means 5 returns to the zero setting duringejection. The switching on of first display 3 can be achieved by settingmean sensor 17 sensing that the dose setting means 5 has returned to thezero setting during ejection. With reference to FIG. 6 and FIG. 25sleeve 14 move s downward during ejection of the medicament so thatmember 29 reaches switch 18 when actuation means 12 is depressed so thatthe zero setting is reached. Thereby, the first display 3 isautomatically switched on. This enables the user to tag the injectionevent as described below if he or she wishes to do so. Again, theattention of the user is directed to the next step in the procedurewhich is using the first display 3 to log the injection event.

In one embodiment the first display 3 and second display 6 are notvisible at the same time by the user, such that the user cannot read thefirst display at the same time as the second display. An advantage withthis arrangement is that the user can not confuse the values on the twodisplays. The two displays 3, 6 can, for example, be geometricallyarranged such that it is only possible to see one display at a time.Alternatively one display can be of a kind where the digits are onlyvisible from a certain angle.

Preferably the displays 3, 6 are on different surfaces on the housing ofthe device as shown in FIG. 11-12 where the first display 3 is arrangedon a first side 20 of the housing 7 and the second display 6 is arrangedon second side 21 of the housing 7. The relationship of the surfaces ofthe displays 3, 6 can be defined by the angles of the surfaces of thedisplays. FIG. 12 shows an example of an elongated housing 7 of device 1seen from the dosing knob 5. The angle α between a line perpendicular tothe surface of the first display 3 and a line that is perpendicular tothe surface of the second display 6 is at least 45°, more preferably60°, more preferably at least 70°, more preferably at least 80° mostpreferably at least 90°. “Line perpendicular” to the surface of displayrefers to a line that goes through the surface of the display on thepart of the display where the indicated number, letter or symbol isvisible. Typically this will be the direction from where the user mostconveniently observes the display. When the angle α is 45° or more it isdifficult for the user to see both displays at the same time, whichreduces the risk of confusing the two displays and further directs theattention of the user/patient to one display at a time.

The device 1 can be equipped with a lancet mechanism 22 b with a sitefor connecting a replaceable lancet 22 as shown schematically in FIG. 1and FIG. 13. The lancet 22 is typically a sharp needle made of surgicalgrade steel that is able to make a small puncture in the skin in orderto obtain a drop of blood, to be used in blood glucose measurement.Typically the lancet 22 is powered by a spring mechanism 22 b andejected after interaction by the user, for example when the user pressesan actuator. Preferably the lancet 22 and its mechanism 22 b iscontained in the housing 7 when not in use, the tip of the lancet 22being ejected trough a small opening in housing 7 when the user pressesan actuator. The lancet 22 should be ejected with a speed that issufficiently for the lancet 22 to puncture the skin and preferably havea stroke depth of 2-3 mm. Lancet mechanisms are well known in the art.An example of a spring mechanism for a lancet is disclosed inWO2009027950. The lancet 22 can also be powered by compressed gas. Anadvantage for including a lancet 22 in the device is that there arefewer loose things for the user to keep track of.

The housing 7 of the device 1 can be elongated, and roughly have theproportions as shown in FIG. 13 and FIGS. 4 and 5. Again, the size ofthe housing 7 is such that it can conveniently rest in the hand of theuser. When the housing 7 is elongated, the lancet 22 or the site forconnecting the lancet 22 is preferably located so that lancet needle isin one end 23 of the housing 7 and the cartridge housing 10 ispreferably located in the opposite end 24 of the elongated housing 7 sothat the needle 42, when connected, is in the opposite end 24 of thehousing 7. This may also apply when the housing is not elongated.Furthermore the injection actuator 12 is preferably located on the sameend 23 of the housing 7 as the site for connecting a lancet 22. This hasthe advantage that the user, when he or she is positioned to interactwith the injection actuator 12, for example has a finger positioned todepress the injection actuator 12, he or she does not try to injecthimself with the lancet 22. This provides additional safety.

When the housing 7 is elongated the first display 3 is preferablylocated in the middle of elongated shape as shown in FIG. 13. When thedevice 1 comprises a glucose meter 9, the test strip port 2 is alsopreferably located in the middle of the elongated shape as shown in FIG.13. In this manner the interaction points of the user for glucosemeasurement is located in the middle of the housing 7 of device 1. Thus,the middle of the area of the first display 3 is located approximately50% from the end of the housing 7. Approximately 50% includes 30% to70%, even more preferably 35% to 65% and most preferably 40% to 60% ofthe distance from the end of the housing. Furthermore, the seconddisplay 6 is preferably located at one end of the housing, preferablythe same end 23 as lancet 22. This further separates the first andsecond displays 3, 6 and mentally connects each display 3, 6 to acertain way of interacting with the device, which makes it easier toremember. It also has the advantage that the first display 3 is clearlyvisible when the device is held with two hands.

For further indicating the work flow and allocating the various functionto different parts of the device 1 the angle β between the lancet 22,when the device has a site for connecting a lancet, and the injectionneedle, when connected, is preferably about 160°-220°, more preferably170°-190°, most preferably about 180°. Thus, the lancet 22 and theinjection needle 42 are pointing in different directions. Although theinjection needle 42 is not a part of this invention, the direction ofthe injection needle 42 is determined by the direction of the cartridgehousing 10.

The test strip port 2 comprises an opening in the housing 7 and anelongated tunnel which guides the test strip into the glucose meter 9.Suitably the cross section of the tunnel is somewhat larger than thecross section of a test strip so that the test strip is guided into theglucose meter 9. When the device has a lancet 22 or a site forconnecting a lancet and glucose meter, the test strip port 2 ispreferably arranged such that the angle γ between the test strip 28,when inserted into the test strip port 2, and the lancet 22 is from 45°to 135°, more preferably from 80° to 100°, most preferably about 90°.

When the device has a glucose meter 9 the angle δ between the test strip28, when inserted into the test strip port 2, and the injection needle42 is preferably from 45° to 135°, more preferably from 80° to 100°,most preferably about 90°.

The device may have an ejection sensor 33 for detecting the amount ofinsulin that has been ejected by the device. Ejection sensor 33 isconnected to drive mechanism 13 such that it can send a signal to theprocessing unit 19 that is related or proportional to the amount ofinsulin that is ejected by the injection means of the device. An exampleof the arrangement of such a sensor is shown in FIG. 6 which shows asensor which detects rotation of turning part 27 of drive mechanism 13.Turning part 27 which is a part of drive mechanism 13 has a rim whichforms a cogwheel 32 to which cogwheel 31 is connected. Turning ofcogwheel 31 is detected by magnetic ejection sensor 33 which is able tosend a signal to the processing unit 19. When the user presses actuationmeans 12 the turning part 27 turns during ejection of insulin. Turing ofturning part 27 causes turning of cogwheels 32 and 31. The turning ofthe cogwheel 31 and the signal from the magnetic ejection sensor 33 isproportional to the turning of turning part 27 and thus to the amount ofinsulin that has been ejected.

The medical device 1 can be equipped with a proximity sensor 35connected to processing unit 19. The proximity sensor 35 can sense thepresence of a solid object, preferably the body or a part of the body ofa person. Preferably this is archived without making contact with theobject. The proximity sensor should be able to detect the body of theuser if the skin is bare or covered by clothing. It should also be ableto detect a human body irrespectively of various skin hues.

The proximity sensor 35 can be a distance measuring sensor that sends asignal to the processing unit 19 that can be converted to a distancemeasurement. Alternatively, the sensor can be a binary proximity sensorsuch that it does not actually measure or quantify the distance butproduces a detectable signal change if a solid object is within athreshold distance.

Suitably the proximity sensor 35 is arranged to send a detectable changein a signal when an object is within a threshold distance. Thus thesensor can be arranged to send a signal when an object is within thethreshold distance and to cease to send the signal when there is noobject within the threshold distance. The sensor may alternatively bearranged to continuously send a signal if there is no object within thethreshold distance, but to cease to send the signal when there is anobject within the threshold distance. The threshold distance T isdefined as shown in FIG. 14; from the inside of the front plate 4 of thecartridge housing 10 and in the direction of the injection needle 42

Preferably the proximity sensor 35 reacts to an object with a certainthickness, such that it does not sense a finger or a small object thatpasses through the detection zone, but does react to a larger objectsuch as the leg or the stomach of the user. Thus the proximity sensor 35should be such that it detects the distance from the medical device 1 tothe body or a part of the body of a patient that is suitable to receivean insulin injection.

Proximity sensors may be based on heat, IR (infrared light), ultrasoundor radio sensing, where IR is preferred. Sensing can be based onamplitude, frequency, phase shift or shielding of the object. Thedesired signal may be derived in change in, for example, capacity orsensors may comprise a transmitter and a receiver. Preferably the IRsensor has a transmitter that transmits IR and a receiver that receivesIR that is deflected by a solid object. LEDs are conveniently used fortransmitting the IR wave. Examples of proximity sensors are disclosed inU.S. Pat. No. 8,536,507 B2 and U.S. Pat. No. 8,350,216 B2.

As discussed above, the user is instructed to prime the injections meansbefore each injection.

The sensor 35 can be used to automatically distinguish priming eventsfrom injection events as shown in FIG. 15, FIG. 19 and FIGS. 20-22. Thisis based on that the user primes the injection means in the correctmanner, i.e. does not prime the injection means by injecting into anobject, but instead ejects so that the tip of the needle can beobserved, so that the user can observe the ejection of insulin from thetip of the needle When the device 1, with the aid of the proximitysensor 35 senses that a solid object 50 is within a certain distance Tit is assumed that the ejection event is an injection event and whenthere is no object 50 within a certain distance T it is assumed that theejection event is a priming event.

FIG. 20 is a schematic view showing device 1 with needle 42 pointed inthe direction of a solid object 50. The proximity sensor 35 withdetection zone 51 are also shown. In this figure the solid object 50 isnot within the threshold distance T and the ejection event is logged asa priming event.

FIG. 21, shows essentially the same as FIG. 20 but here, on the otherhand, a solid object 50 (the body of a patient), is within the thresholddistance T and the ejection event is logged as an injection event. Thedetection zone is not shown in FIG. 21 for sake of clarity.

Preferably the proximity sensor 35 is arranged to transmit and receivethrough an opening in the housing 7. Preferably, proximity sensor 35 isplaced close to the tip of the needle as practically possible, directedto sense in the direction of the tip of the needle. Sensing by theproximity sensor 35 preferably takes place approximately in thedirection of the needle 42, such that it can detect when an object is infront of the tip of the needle.

The signal from the proximity sensor 35 can be used to distinguishbetween injection events and priming events as described below. Suitablythe signal from the proximity sensor 35 is received by the processingunit 19 which can use the signal to distinguish between priming eventsand injection events.

Various connections to the processing unit 19 is shown in FIG. 17. Thedevice 1 comprises a processing unit 19 for controlling the device. Theprocessing unit receives data from glucose meter 9, setting mean sensor17 (which may comprise switch 18), ejection sensor 33 and proximitysensor 35. Processing unit 19 also receives input from the user andcontrols the first display 3. For example, processing unit 19 may storeinformation in a database 200 that can be displayed on the first display3 in the form of an electronic log. The processing unit 19 may be anintegrated circuit, which using today's technology can have anarchitecture which is in the order of nanometers, e.g. as used in mobilephones. Thus the processing unit 19 does not take up much space in thehousing 7. A memory 38 is also provided to allow the user to store data,for example logging injections and blood glucose measurements,preferably in the form a database 200. The processing unit 19 can alsobe connected through a data port 39 to a computer for extracting dataand for updating any software stored on the device 1. Such a connectioncan be for example a USB or a micro USB connection. The data port 39 mayalso be a wireless connection such as a Bluetooth or a Wi-Fi connection.

The processing unit 19 may have an interface for a switch 18 of settingmean sensor 17 that detects when the dose setting means 5 is set to asetting that permits ejection of insulin.

Processing unit 19 may also have an interface for ejection sensor 33which detects insulin ejections carried out by the insulin injectionmeans.

The processing unit is powered by a power source such as a battery 34.Battery 34 also powers other components of the device that requireselectricity such as the first display 3 and integrated glucose analyzer9. The battery 34 can preferably be reached and replaced through a coverin the housing 7. The connection for charging may be a USB data port 39.Data port 39 also may also conveniently be used for retrieving datastored in the memory 38 of the processing unit 19.

The processing unit 19 is also connected to the first display 3 and tointegrated blood glucose analyzer 9 and to proximity sensor 35.

The processing unit 19 may further have a manual input device 36 whichmay for example be buttons, a mini joy stick, a navigation plate orsimilar device for inputting data and for navigating and scrolling inmenus shown on first display 3. A clock 37 provides date and timeinformation and can also serve as a timer for the processing unit 19.

The processing unit 19 includes a memory 38, such as, for example, aflash memory, for storing software and data generated by the device 1and by the user, e.g. the database 200. The memory 38 does notnecessarily have to be enclosed in the device 1 but it can also beaccessed through a wireless connection, for example a wireless network.

The database 200 can be used to log blood glucose measurements andinsulin ejection events in a log so that the user, or a technician ormedical staff can retrieve the events.

In a preferred embodiment the device 1 has an integrated electronic logfor logging blood glucose measurements and insulin ejection events. Theelectronic log is essentially a database 200 stored in the memory 38 ofthe processing unit 19 where the database 200 is accessible through theuser interface, preferably the first display 3, of the device in aconvenient manner. The glucose measurement events and ejection eventsare stored as entries in the database 200. One schematic overview overan example of database 200 is shown in FIG. 16.

By way of example, the user, a technician or medical staff can accessthe electronic log by choosing an appropriate command in the menu byscrolling through the display using +/− buttons and then see a list ofblood glucose measurements or ejection events, or both. Preferably thedefault is that the events are shown in date order with the most recentevent shown first. Ejection events and glucose measurement events can betagged by the user with additional information, that is, additionalinformation regarding the events may be stored in the database.

FIGS. 15, 18 and 19 are flowcharts showing examples of how theprocessing unit 19 and sensor 35 operates when the user carries outtreatment and logs events according to the method for logging accordingto the invention. The steps shown in FIGS. 15, 18 and 19 are under thecontrol of software programs stored in the memory and executed by theprocessing unit in a conventional fashion. Any suitable programminglanguage or technique can be used to implement the database and theelectronic log.

In its most general form the method for logging injections of amedicament is an implementation of the method schematically shown inFIG. 15. The electronic log comprises a database 200 which is stored inthe memory 38 of processing unit 19. In step 600 an ejection event isstored in the memory of the device 1, the ejection event comprisinginformation about the amount of ejected medicament and the time and datefor this. During or immediately after the ejection process, theproximity sensor 35 senses if there is a solid object 50 in theproximity in the direction of the injection needle. Also in step 600,the processing unit 19 receives a signal from the proximity sensor 35.If there is no solid object in the proximity, for example if a thresholdvalue for the distance to a solid object is exceeded, a decision is madeby processing unit 19 in 601 to tag the ejection event in the memory asa priming event in 602. If there is a solid object in the proximity, theejection event is tagged as an injection in step 603.

Preferably the method is carried out automatically by the device 1. Thedetermination in step 601 can be carried out in different manners. Inthe case when the proximity sensor 35 sends a signal that can beconverted to a distance measurement, the signal may be processed by theprocessing unit 19 which has stored the threshold value and compares thesignal with the threshold value and makes the decision in 601. In thecase of a binary proximity sensor, the proximity sensor 35 itselfdetermines if there is a solid object within the threshold distance andsends a signal regarding this to the processing unit 19.

In a preferred embodiment, the threshold distance T can be set inrelation to a position that is fixed in relation to the injectionneedle, preferably the front plate 4 of the of cartridge housing 10. Thethreshold distance T is measured from the inner surface of the frontplate 4 to the longest distance where a solid object, such as a humanbody, causes a change in a signal that makes an ejection event to beclassified as a priming event can be seen in FIG. 14.

The user is normally instructed to prime the injection means by holdingthe injection means vertically with the needle pointing upward and thenejecting a small amount of medicament while observing that medicament isejected from the needle in a normal fashion, i.e. so that no air is leftin the needle and that the needle is not blocked. Thus in normal use, itis not likely that priming ejections are made with the needle close to asolid object.

Suitably T is chosen so that it accommodates most needle lengths(including the needle hub) while still being short enough so that noerroneous logging takes place, for example, if the user holds the deviceunder a lamp while priming. Needles for injecting insulin are usuallybetween 4 mm and 13 mm long. Thus if an injection is made when there isno solid object within 200 mm, 100 mm, 50 mm, 40 mm, 30 mm, 25 mm, 20mm, 18 mm, or 15 mm from the front plate 4 it is highly likely that theejection event is a priming ejection. These distances accommodates mostcartridges, length of injection needles and length of needle hubs.

The measurement of proximity sensor 35 can preferably be carried outvery quickly (under 1 second) and can be carried out at any time duringthe ejection, or immediately after ejection. Sensor measurement shouldbe carried out at least once during ejection, or immediately afterinjection, that is within 1 second of completing ejection, morepreferably within 0.5 seconds of completing ejecting, as determined byejection sensor 33. Alternatively it is carried out several times duringejection in which case it may be enough for a solid object to be withinthe threshold distance once during ejection as determined by ejectionsensor 33 in order for the ejection event to be classified as aninjection event.

Suitably ejection sensor 33 can be used to determine the time window forwhen ejection takes place. Thus, an ejection event may be logged as aninjection event only if a solid object is within the threshold distanceduring the time when ejection takes place as determined by ejectionsensor 33, or immediately thereafter. Thus if a solid object is withinthe threshold distance only after ejection has ceased as determined byejection sensor 33, the ejection event is not logged as an injectionevent.

Ejection sensor 33 may activate proximity sensor 35, for example bysending a signal to proximity sensor 35. Such a signal can be sent viaprocessing unit 19, or directly from injection sensor 33 to proximitysensor 35.

Alternatively proximity sensor 35 may be switched on by setting meansensor 17 (preferably via processing unit 19) when setting mean sensor17 detects that the setting means 5 is set to a setting that allows theejection of insulin. In this case, the time window for detectingproximity may be determined by ejection sensor 33 as described above.

In the following it is described with reference to FIGS. 18 and 19 howthe user can use the electronic log to log glucose measurements andmedicament ejection events.

A user initializes a test by introducing a test strip 28 into the teststrip port 2. This can be detected by the integrated blood glucoseanalyzer 9 which then automatically switches on the device.Alternatively, the user switches on the device manually by using manualinput device 36. The processing unit 19 may then carry out a systemcheck to see that the device 1 is working properly, and for examplecheck that there is sufficient batter power to carry out the subsequentsteps. Suitably, the first display 3 is then switched on, indicating tothe user that the device is ready for a blood glucose test. Suitably thedisplay 3 at this step displays text that instructs the user tointroduce a blood sample such as “AWAITING BLOOD SAMPLE”. The user thentakes a blood sample, suitably by using the lancet 22, and places a dropof blood on the test strip. If this is not done within a suitable timeframe, such as 5 minutes, the program in the processing unit 19 may shutdown the device 1 in order to save battery. When a blood sample isintroduced, the integrated blood glucose analyzer 9 can automaticallydetect this and produce a blood glucose measurement. Since it takes timeto do this, the processing unit 19 suitably indicates to the user on thefirst display 3 that blood glucose measurement is in process, forexample by counting down a timer or showing the text ANALYZING. Usually,5 seconds is sufficient to analyze the blood sample. The device may thendisplay an instruction to withdraw the test strip 28 from the test stripport 2. The blood glucose measurement is stored in the database 200 inthe memory 38 of the processing unit together with date and time for theanalysis, as a blood glucose measurement event in step 400. Then theblood glucose value is displayed on the first display 3 in step 401. Theuser may now be given the opportunity, in step 402, to store additionalinformation together with the blood glucose measurement event in thedatabase 200 in step 403. This can include adding a data point thatindicates one of the following: if the user recently has taken a meal,if the user recently has carried out exercise, or if the user is feelingill. This procedure is referred to as “tagging” the blood glucosemeasurement event. For example by scrolling in the menu, the user firstselects “TAG” and then one of “MEAL”, “EXERCISE” and “ILLNESS”. If theuser chooses in step 402 not to add a tag, the device 1 canautomatically switches off in step 404 after a certain time ofinactivity, for example 10 seconds.

The blood glucose measurement events and ejection events in the database200 can be accessed at any time by the user, technician or medicalstaff. This can be done, for example, by starting the device 1 andselecting a command, for example “LOG” in the menu. The user can readthe various blood glucose measurement events as a list by scrollingthrough the menu. Suitably, the database 200 can also be accessedthrough the data port 39, so that the contents of the database 200 canbe transferred to a PC, tablet computer or other computing device.

Insulin ejection events can be stored in the database 200 in thefollowing manner. In step 500 of FIG. 19 the processing unit 19 detectsan insulin ejection and determines the amount of insulin that wasejected. This can be achieved by the ejection sensor 33 sending a signalto processing unit 19.

When the injection means are designed with setting mean sensor 17 theprocessing unit 19 may use a signal from setting mean sensor 17 to beready to receive input from ejection sensor 33 as follows: When settingmean sensor 17 sends a signal to the processing unit 19 that the dosesetting means is set to a setting that permits the ejection of insulin,processing unit 19 is set in a state so that it is ready to receive asignal from sensor 33 and sensor 33 is set in a state where it is readyto create and send a signal to processing unit 19. Thus ejection sensor33 can be activated by setting mean sensor 17.

The signal from setting mean sensor 17 may also be used by processingunit 19 to be ready to receive input from proximity sensor 35 asfollows: When setting mean sensor 17 sends a signal to the processingunit 19 that the dose setting means is set to a setting that permits theejection of insulin, the processing unit 19 is set in a state so that itis ready to receive a signal from proximity sensor 35 and proximitysensor 35 is set in a state where it is ready to create and send asignal to processing unit 19. Thus proximity sensor 35 can be activatedby setting mean sensor 17.

Information about the amount of insulin that has been ejected is storedin the memory 38 of the device, preferably in the database 200, as anejection event together with date and time for ejection in step 501.

In step 502 the proximity sensor 35 senses whether ejection takes placein the proximity of a solid object. The proximity sensor can beconfigured to continuously measure proximity during the time ofejection, and the fact that step 502 is after step 500 and 501 in FIG.19 merely reflects that the signal from the proximity sensor 35 can beprocessed by the processing unit 19 after the storing of the ejectionevent (step 501). This can suitably be done once immediately afterbeginning ejection (as, for example, determined by ejection sensor 33)or immediately after finishing ejection. The presence of a solid objectduring that one time may be sufficient to log the ejection event as aninjection event.

If the distance to a solid object is larger than the set threshold valueT the ejection event is tagged as a priming event in step 504. If thethere is a solid object within the threshold distance the ejection eventis determined to be an injection event and the ejection event is taggedas such in step 505.

Information about the ejection event can then be displayed, step 506, onthe first display 3 of the device. Preferably this occurs when ejectionis completed as detected by dose setting sensor 17 or by ejection sensor33. The user may then be given the opportunity in 508, to tag theejection event in step 507 in the same manner as the glucose measurementevent can be tagged. Preferably, the ejection event is only displayed onthe first display 3 after ejection is completed. Tagging is suitablyavailable within a certain time frame which can be 10 seconds. Afterthat time frame the device shuts down in step 509 in order to savebattery.

Again tagging can include one of the following events: if the userrecently has taken a meal, if the user recently has carried outexercise, or if the user is feeling ill. For example by scrolling in themenu, the user first selects “TAG” and then one of “MEAL”, “EXERCISE”and “ILLNESS”.

The injection event can be automatically connected in the database 200to a blood glucose measurement event in the database if the injection ismade within a certain time of making a blood glucose measurement. Thattime can be 60 minutes, 30 minutes, 20 minutes, 15 minutes or 10minutes. Preferably the time is 30 minutes after or before a bloodglucose measuring event. Even more preferably, the time is 30 minutesafter a blood glucose measurement event. This is carried out by storingin the memory 38 information that links or associates the injectionevent to the blood glucose measurement event.

The ejection event in the database 200 can be stored together withinformation if whether the ejection was a injection event or a primingevent. The electronic log can be such that ejection events that aretagged as priming events are not accessible to the user via the userinterface on the device 1. For example, they are only accessible afterentering a code or through the data port, or both. This has theadvantage that the user does not usually have access to and does not seethe priming events and does not confuse the injection events in the logwith the priming events. The priming events of the database are stillaccessible for a medical doctor or nurse that wants to check up on thecompliance of the user, or a technician that performs service on thedevice. The injection events in the log are, however, suitablyaccessible to the user. For example the user may view information aboutthese on the first display.

FIG. 16 is a schematic representation of an example of a database 200containing two exemplary entries representing insulin ejection events.Event 201 is an example of a priming event and event 202 is an exampleof an injection event, which has been tagged with MEAL by the userbecause the patient has taken a meal in connection with the injection.Event 201 is present in the database 200 but may not be visible to theuser through the interface of the device 1.

The database 200 can be such that ejection events are classified asinjection events by default and storing a tag with the ejection eventclassifies it as a priming event as seen in FIG. 16. Alternatively, thedatabase 200 can be such that that ejection events are priming events bydefault and storing a tag with the ejection event classifies it as aninjection event.

In an alternative embodiment the method the electronic log takes thelength of the needle into account in a manner shown in FIG. 22. In thisembodiment an ejection event is classified as an injection, if, wheninsulin is ejected, the distance from the sensor to the tip of theneedle (D₁) is larger than the distance from the sensor to an object(D₂) and whereD ₁ −D ₂≥distance A

In this embodiment, an ejection event is logged as an injection event ifthe needle has entered at least A mm into the solid object, i.e. thebody of the patient. A shall be chosen to accommodate the fact that theneedle shall enter the body sufficiently and that also take into accountthat injection can be done through clothing such as a loose-knittedsweater. A can for example be, 0.1 mm, 0.5 mm, 1 mm, 5 mm or 10 mm,depending on the length of the needle. Thus the length of the needle hasto be entered into and stored in the memory of the processing unit 19 oras hardware.

The invention claimed is:
 1. A portable medical device for injectinginsulin into a user, comprising: a control circuit; a blood glucosemeter; an electronically driven display configured to be driven by thecontrol circuit to display a glucose concentration of a blood sample asdetermined by the blood glucose meter; a user manipulable member forselectively setting a user-defined amount of insulin that the portablemedical device is to inject, settings of the manipulable member includeat least two settings, including: a first setting in which no insulin isejectable from the portable medical device and in which glucoseconcentration is displayed on the display, and a second setting in whichthe user-defined amount of insulin is ejectable from the portablemedical device; a sensor that detects change from the first setting tothe second setting and wherein, upon detection of the change from thefirst setting to the second setting and prior to ejection of any of theuser-defined amount of insulin, the control circuit controlling theelectronically driven display from displaying the glucose concentrationto switch off the electronically driven display; and a second displaythat is configured to display the amount of insulin corresponding to acurrent setting of the user manipulable member.
 2. The portable medicaldevice of claim 1, wherein the second display mechanically changes inaccordance with the user manipulable member.
 3. The portable medicaldevice of claim 1, further comprising a drive mechanism that forcesejection of the insulin from the portable medical device, the drivemechanism being powered by the user.
 4. The portable medical device ofclaim 1, wherein the control circuit automatically switches on theelectronically driven display when the user manipulable member ischanged from the second setting to the first setting.
 5. The portablemedical device of claim 1, further comprising: a lancet retainerconfigured relative to a first end of a housing of the portable medicaldevice so that a sharpened end of a lancet retained by the lancetretainer is directed from the first end during use to draw a bloodsample from the user; and an insulin cartridge retainer configuredrelative to a second end of the housing so that a sharpened end of aninjection needle connected to an insulin cartridge that is retained bythe insulin cartridge retainer is directed from the second end of thehousing, the second end opposite the first end so that the sharpened endof the lancet and the needle are longitudinally opposed.
 6. The portablemedical device of claim 5, wherein an injection actuator is located atthe first end of the housing.
 7. The portable medical device of claim 5,wherein the electronically driven display is located on the housingapproximately midway between the lancet retainer and a position wherethe injection needle connects to the insulin cartridge.
 8. The portablemedical device of claim 5, wherein the blood glucose meter is configuredto test blood on a blood test strip, a port to receive the blood teststrip located on a sidewall of the housing between the first and secondends.